Provider Demographics
NPI:1336120799
Name:PARSON, SHANE EVERETT (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:EVERETT
Last Name:PARSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 S ALEXANDER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33510
Mailing Address - Country:US
Mailing Address - Phone:813-717-7553
Mailing Address - Fax:813-717-7593
Practice Address - Street 1:1514 S ALEXANDER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:813-717-7553
Practice Address - Fax:813-717-7593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70010OtherBCBS
FLCH8350OtherLICENSE
FLK5367Medicare ID - Type Unspecified
U67258Medicare UPIN